INSTRUCTIONS

Please fill out all the necessary information. Submit this form in an excel file format to csiw@psycs.org .
Deadline:
December 3, 2019

SHEET 2: List of Participants

Completely fill out the required information. Please be accurate and precise when answering. Follow the
format indicated.

NOTE: For the NCSIW shirt size column, refer to the picture on the right side of the table. Then choose
from the drop-down list the appropriate size.

SHEET 3: Contests

Please refer to NCSIW 2019 Primer for the CONTEST GUIDELINES

Write COMPLETELY and CORRECTLY the names of the students and/or teachers in the appropriate
column of contests. Contact number of the coach shoul be filled out as well. The maximum number of
participants allowed per school is also indicated.

SHEET 4: Loyalty Award

Write COMPLETELY and CORRECTLY the names of the students and teachers who are qualified to be
Loyalty Awardees. The Loyalty Award is given to those who have already joined three (3) consecutive
NCSIWs including this year. For teachers, please indicate the year you received your last Loyalty Award.

NOTE

In accordance to the Data Privacy Act of 2012, all personal information collected will be confidential, and
will only be used for the purposes of this event, such as record keeping of the participating school's
contact details.
2019 National Children's Science Inter
ASTROQUEST: UNRAVEL THE MYSTERY
NAME OF SCHOOL

CONTACT NUMBER(s)
EMAIL ADDRESS
List of Participants

NAME OF PARTICIPANT

LAST NAME FIRST NAME MI NICKNAME

1 Ramoso Gupiter King M Gupiter

2 Dela Cruz Kian Andrei R Kian
3 Wong Ryan Jacob V Ryan
4 Custodio Shaun Kevin T Kevin
5 David Lanz Victor A Lanz
6 Eduarte Hilario Miguele E Miggy
7 Deveraturda Lucas Marion M Lucas
8 Ealdama Heizel Joy A Heizel
9 Moreno Realyn D Rea
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…
ence Interactive Workshop
E MYSTERY OF THE LOST STARSHIP

CONTACT NUMBER
Birthday
OF PARTICIPANT

Teacher, Student, Month/Day/Year (e.g. 0905-366-1989)

Parent
Student 8/10/2009
Student 1/17/2011
Student 1/6/2010
Student 08/27/2010
Student 01/22/2010
Student 05/20/2010
Student 06/22/2010
Student 6/23/2010
Teacher 8/29/1981
TARSHIP

NETWORK EMAIL ADDRESS

(e.g. Smart/TNT/TM/Globe/Sun) (e.g. psysc.ncsiw2018@gmail.com)

130 Burgos St., Baraca Camachile, Subic, Zambales

Lot 27, Blk. 7, Lincoln Heights, Dinalupihan, Bataan
Lot 19, Blk.9, Roosevelt Park Village, Dinalupihan, Bataan
8 1st St., Banicain, Olongao City
Purok 12, La Union St., Barretto
Blk.1 Lot 36-38, Lincoln Prime, Dinalupihan, Bataan
43 Corpuz St., West Tapinac, Olongapo City
Lot 6 Blk 8, Fiesta Communities, New Cabalan, O.C.
130 Burgos St., Baraca Camachile, Subic, Zambales
 SPECIAL
ADDRESS FOOD RESTRICTIONS MEDICAL
CONCERNS
[Number, Street,
Barangay/Village,
(Refer to the legend on the right)
City/Municipality,
Province]
ic, Zambales XXS
han, Bataan XS
nalupihan, Bataan

XL
han, Bataan XL
nuts XXS
abalan, O.C. M
ic, Zambales
 CONTACT
NUMBER OF
NCSIW SHIRT SIZE
NAME OF PARENT/ GUARDIAN
PARENT/GUAR
DIAN
(Refer to the picture on the right for (e.g. delacruz, (e.g. 09xx-xxx-
the sizes) Juana.) xxxx)
diagnosed with ASD Rhea Moreno 9328856159
Irene Dela Cruz
XL Catherine V. Wong 9228688711
XXL Mary Ann Custodio 9338509194
Jennifer David 9969130789
Ces Eduarte 932590570
Yvet Deveraturda 9055571125
Joy Ealdama 9999907800
adult small 9328856159
 LIST OF FOOD RESTRICTIONS NCSIW 2018 SHIRT SIZES

Pork P

Chicken Ch

Beef B

Goat G

Fish F
RELATIONSHIP TO
PARTICIPANT
Mollusk M

(e.g. Mother)
Innards I
Mother not applicable N/A
Mother Crustacean Cr
Mother
Mother
Mother
Mother
Mother
Mother
NCSIW 2018 SHIRT SIZES
 NCSIW 2019 CONTESTS
ASTROQUEST: UNRAVEL THE MYSTERY OF
For contests guidelines, please refer to the NCSIW 2018 Prime
PROGRAMS CONTEST
Yule Celebration: A
SCIENCE EXPOSED TAKE HOME WORKSHOPS ENTERTAINMENT NIGHT
Pasalubong Festival Space Odyssey: A Costume Play Galactica: A Dance
Competition Ckloud Competition
Vench Angelo F.
Charles Andrei T. Hermida 1 Amber Louisse M. Daguman Ralph Benedict A. Bolanos Gloria
Lione Marq G. Jacinto 2 COACH Mariol Theona S. Alcantara Fairy Lei S. Cara
COACH 3 1 COACH Lorin Estelle C. Ecura
1 4 Insert Contact Number Cesca Lian G. Garganta
Insert Contact Number Insert Contact Number Sadie Jordin M. Jimeno
Zhiena Airah E. Lavarias
Marianne Camille M. Valencia
Cashmere Gayle D. Calara
Precious Yvonne V. Camaso
Maria Sophia T. Salas
Thomas Julian H. Barcellano
Andrew Joachim V. Ausa
Lance Yosef V. Lapid
Daniel Angelo Wyatt Palma
Jershey Kace P. Aranas
Yanzley Gail M. Arazas
Eyriel Cassandra P. Dizon
Princess Sachi Nomura
Hannah Kellsy M. Valencia
Chineil Ashly D. Gonjoran
COACH
1
Insert Contact Number
ONTESTS
TERY OF THE LOST STARSHIP
the NCSIW 2018 Primer.
SESSIONS CONTEST
DECLAMATION CONTEST SCHOOL QUIZ COMPETITION POSTER MAKING CONTEST ESSAY WRITING CONTEST
Kathrine Tiania Alessandra Basobas Eunice Alexndria A. Sta. MariDaine Margaret M. Nacorda
COACH Dave Railey K. Sillano COACH COACH
1 COACH 1
Insert Contact Number 1 Insert Contact Number Insert Contact Number
Insert Contact Number

e M. Valencia

. Barcellano
 LOYALTY AWARD [Students]
NOTE: The LOYALTY AWARD is granted to students who joined three (3) consecutive
NCSIWs including this year.

NAME OF AWARDEE GRADE LEVEL

Last name First Name MI (e.g. Grade 6)

1
2
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5
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 LOYALTY AWARD [Teachers]
NOTE: The LOYALTY AWARD is granted to teachers who joined three (3) consecutive
NCSIWs including this year.
Year of Last Loyalty
NAME OF AWARDEE Award
Last name First Name MI (e.g. CSIW 2015)
1
2
3
4
5
6
7
8
9
10
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